Annals for Educators - August 2022
Authors: Christine Laine
Journal: Annals of Internal Medicine (2022)

Web ExclusivesAugust 2022Annals for Educators - August 2022FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202208160 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsCannabis-Based Products for Chronic Pain. A Systematic ReviewCannabinoids for Chronic Pain: Translating Systematic Review Findings Into Clinical ActionPatients and physicians are interested in alternative treatments for chronic pain. Cannabis derivatives, or cannabinoids, including tetrahydrocannabinol (THC) and cannabidiol (CBD), may have analgesic properties. This systematic review investigated the benefits and harms of cannabinoids for treating chronic pain. The authors of the accompanying editorial discuss the limitations and strength of the available evidence and share their own advice for engaging with patients interested in using cannabis to treat chronic pain.Use this article and the editorial to:Watch the animated video summarizing the systematic review with your learners. Review the various cannabinoids and what is known about their potential therapeutic effects, adverse effects, and addiction potential. This In the Clinic review provides useful information. Ask your learners if they have cared for patients who use cannabis as therapy for medical conditions. What conditions do their patients use it for? Do patients report benefit?Review cannabis-related laws in the state your health system serves. Is medical cannabis legal?If medical cannabis is legal in the state your health system serves, how can clinicians refer patients for treatment?A Novel International Monkeypox OutbreakMonkeypox: Avoiding the Mistakes of Past Infectious Disease EpidemicsAdding New Fuel to the Fire: Monkeypox in the Time of COVID-19—Implications for Health Care PersonnelThese 3 articles discuss the ongoing multinational outbreak of monkeypox infection. The first article discusses what a monkeypox case might look like to enable rapid, appropriate medical and public health interventions by U.S. clinicians, many of whom have never seen a case of monkeypox. In the second article, experts from the Centers for Disease Control and Prevention discuss what is currently known about the epidemiology and clinical manifestations of recent monkeypox cases and outline how best to work with patients and communities to recognize the illness and limit transmission while avoiding stigma and bias. The authors of the third article believe that health care workers must understand the threat presented by monkeypox and be prepared to address an infectious disease risk that may herald yet another unprecedented epidemic.Use these articles to:Discuss whether there have been any patients diagnosed with monkeypox at your institution. To which setting did these patients present? What was the clinical presentation?Invite an infectious disease specialist to your teaching session to review the local procedures for monkeypox testing, obtaining antiviral therapy, and vaccination.With your learners, listen to the Annals On Call podcast that features a discussion about monkeypox. Quantifying Individual-Level Inaccuracy in Glomerular Filtration Rate Estimation. A Cross-Sectional StudyPopulation-level differences between estimated and measured glomerular filtration rates (eGFRs and mGFRs) are well recognized. This study quantifies the magnitude of less well-known individual-level differences between mGFRs and eGFRs and examines the clinical implications.Use this article to:Review a few laboratory reports for your learners' patients. What methods do the laboratories affiliated with your institution use to estimate GFR?Review the findings of this study.Discuss whether the findings of this study justify advocating for changes in how your laboratory estimates GFR.There has been controversy over the inclusion of race in equations to estimate GFR. Ask your learners to share their views about the benefits and harms of including race in these equations. This commentary and this Annals On Call podcast can help to stimulate discussion. Race, Genotype, and Azathioprine Discontinuation. A Cohort StudyBeyond Race: A Wake-up Call for Drug Therapy Informed by GenotypingBenign neutropenia related to an ACKR1 variant (rs2814778-CC) is common among persons of African ancestries. In this study, the authors assessed whether rs2814778-CC was associated with azathioprine discontinuation attributed to hematopoietic toxicity and lower thiopurine dosing, independent of race and across indications. The accompanying editorial discusses the critical questions that the research findings elicit.Use this article and the editorial to:Ask your learners to name conditions for which azathioprine is a therapeutic option.Discuss how to distinguish benign neutropenia from clinically significant neutropenia.Explore whether and how clinicians at your institution could obtain testing for the genetic variant described in this study for their own patients.Discuss how this study elucidates the potential harms of using race as a proxy for genetic and other biological factors.Beyond the GuidelinesHow Would You Treat This Patient With Pulmonary Embolism? Grand Rounds Discussion From Beth Israel Deaconess Medical CenterUpdated guidelines on treatment for venous thromboembolism offer many conditional recommendations, particularly in cases of patients with transient risk factors. In this article, a hematologist and a cardiology and vascular medicine specialist discuss the care of a patient with pulmonary embolism with regard to these guidelines.Use this article to:Watch the patient video with your learners, and then ask how they would manage this patient.Discuss the advantages and disadvantages of prescribing long-term anticoagulation in this clinical situation.If anticoagulation were to be prescribed, which agent would they choose?Have your learners test their knowledge by completing the quiz that accompanies the article.Eating DisordersEating disorders are common behavioral disorders associated with substantial psychological and physical morbidity and mortality. Persons with eating disorders frequently present to primary care providers, who may also be responsible for their general medical management. This article reviews the diagnosis, medical assessment, and treatment of the most common eating disorders.Use this article to:Discuss the presentation of eating disorders.Ask your learners if they have any patients in whom they have diagnosed an eating disorder.Review the currently available therapeutic strategies for different eating disorders. Discuss the roles of primary care physicians in the treatment of patients with eating disorders.Discuss the indications for hospitalization of a patient with an eating disorder.Test your learners' knowledge by having them complete the quiz that accompanies the article and then reviewing the correct answers.Public HealthLife Expectancy for White, Black, and Hispanic Race/Ethnicity in U.S. States: Trends and Disparities, 1990 to 2019Mapping the Color Line: Racial/Ethnic and Gender Disparities in Life Expectancy Across the United StatesAfter decades of gradual improvements, life expectancy is no longer increasing in the United States. This national trend masks disparities among states and between racial and ethnic groups. This study estimated life expectancy separately by sex for each of the 3 largest racial and ethnic groups across states from 1990 to 2019 to examine trends for each group over time and how they differ. The accompanying editorial discusses how the findings of state-level differences provide an important window into our understanding of how health and well-being can vary drastically within our country.Use this article and the editorial to:Ask your learners for their views on the factors that contribute to the disparities observed in this study.Discuss strategies for reducing disparities within your own institution, in your state, and at the national level. This ACP position paper may help to prompt discussion. Strengthening Food and Nutrition Security to Promote Public Health in the United States: A Position Paper From the American College of PhysiciansFood insecurity is known to adversely affect health. This ACP position paper offers several policy recommendations to strengthen the federal response to food insecurity and empower physicians and other medical professionals to better address this growing problem.Use this article to:Ask your learners if they ever ask patients about their ability to obtain nutritious foods.Ask your learners to name medical conditions for which access to nutritious foods is a critical component of disease management.Role-play conversations related to food insecurity between physicians and patients to explore effective and sensitive ways of obtaining information about this important social determinant of health.Invite a social worker to your session to discuss local community-based programs for people with food insecurity.Announcements From ACPACP Board Prep Curriculum for EducatorsACP's trusted collection of ready-to-use online teaching slides help residency programs prepare the next generation of internists to pass the ABIM certification exam. 69 one-hour lectures, 4000+ prepared slides, 400+ high-yield multiple-choice questions. Preview the sample module here. Herbert S. Waxman Chief Resident Teaching ScholarshipAll chief residents who are members of ACP are eligible to apply for a Herbert S. Waxman Chief Resident Teaching Scholarship. Waxman Scholars assist in teaching popular workshops under the guidance and mentorship of expert faculty in the Clinical Skills Center at ACP's Internal Medicine Meeting. The scholarship includes the cost of meeting registration, travel, and accommodations for the ACP Internal Medicine Meeting 2023, to be held April 27–29 in San Diego, California.This is an opportunity to build your CV and to gain valuable experience teaching a workshop.The submission deadline for applications is September 23, 2022. Don't miss it— click here to complete your application! Do you like reading Annals for Educators? Receive it direct to your inbox. Sign up for the Annals for Educators alert today. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics August 2022Volume 175, Issue 8Page: ED8 ePublished: 16 August 2022 Issue Published: August 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...